Sunday, October 09, 2005

THAT’S HIS STORY AND HE’S STICKING TO IT

I have come to the conclusion that I have been wrong to repeatedly refer to Dr. Paul Offit as Darth Vader. Resorting to such juvenile name-calling is the style of some other bloggers (who shall remain nameless, since they don't use their real names anyway), not me. Although I offer my apologies to Dr. Offit for my little joke, his appearance on Autism One Radio gave me no reason to actually start respecting the man or his opinions.

Autism One Radio provided coverage on the Power of Parents Rally in Washington being held to give the physicians attending the American Academy of Pediatrics a little something to think about. In the midst of that, Paul Offitt was interviewed. I suppose I should give Dr. Offit credit for actually agreeing to be interviewed live on October 8th by Teri Small, but it would be a lot easier to do so if direct answers had been given to Ms. Small’s questions.

I can’t say I was very surprised at anything Dr. Offit had to say, other than his admission that autism “has apparently become more common” in the United States. I suppose that is as close as he can come to using the “e” word. Dr. Offit further vacknowledged that autism probably results from an environmental trigger acting on genetically predisposed children. And he also agreed that some children have genetic predispositions to vaccine reactions. Dr. O just can’t admit that those two concepts have any relation to each other. Why not? In Dr. Offit’s view, the epidemiological reports are irrefutable, no matter what clinical and biological studies indicate.

When Teri asked for a comment about the Burbacher studies, and its finding that ethylmercury crosses the blood-brain barrier, Dr. Offit chose to address the broader question of whether he thought thimerosal was delivered in harmful levels in vaccines. (Was he trying to stick to a script?) He tried to ignore the Brupbacher study, and instead focused on the four epidemiological studies that we have all discussed time and again.

Despite Dr. Burbacher’s findings that indicate the opposite, Dr. Offit continues to insist that methylmercury accumulates in greater and more dangerous quantities than does ethylmercury. With that opinion as a backdrop, Dr. Offit implied that the presence of methylmercury in the environment makes infant formula, or even breast milk, more dangerous than thimerosal in vaccines.

Throughout the interview, Dr. Offit continued to stick to his baseless opinion that methylmercury in the environment presents a greater danger than ethylmercury that was directly injected into our children.

Teri attempted to gently steer Dr. Offit back on track to discuss the implications of the Burbacher study, but he insisted that he had no idea why it should be significant for there to be inorganic mercury in the brain. He insisted that animal studies are not predictive in the least, and that the only proper measure of harm is to study humans. The superiority of human studies is difficult to argue with, but Dr. Offitt feels that the four epidemiological studies tell the whole study.

After Dr. Offit brought up the superiority of human studies, Teri commented that some human tissue studies seemed consistent with the animal experiments, and questioned whether further tissue studies would be useful. Dr. Offit made it clear that he prefers epidemiology to provide a complete answer rather than tissue studies he refers to as “reductionist.”

Let us be clear about reductionist studies. That term refers to the concept that complex problems can be better understood by reducing them to simpler component parts. Reducing complex problems is usually considered a pretty good approach in science; it prevents researchers from traveling down the wrong road. Yet Dr. Offit spit out the word as if it were a curse.

Dr. Offit believes that only epidemiological studies can answer the question of whether thimerosal can be related to the development of autism. When confronted with the statements by Dr. Verstraeten that the study he prepared neither proved nor disproved a connection, Dr. Offit said Dr. Verstraeten merely meant that the study was not probative until it was replicated, and that the other three studies successfully replicated the findings. Is he kidding???

The other three studies had nothing to do with Dr. Verstraeten’s report. They addressed different populations using different criteria. If one wanted to replicate the Vertsraten study, one would need to access the same data upon which the report relied. But as we all know, that replication cannot occur because the data is now “unavailable.”

Epidemiology has a place in the inquiry, but it cannot form the only basis for answering the question of whether component parts of a vaccine can trigger autistic symptoms in a susceptible child. Epidemiology can be too easily manipulated to produce the result the researcher (or the researcher’s principle) wants. For that reason, I have always likened epidemiology more to forensic accounting than to hard science. A well designed epidemiological study (and I certainly do not think any of the four studies at issue were well designed) can help define the questions, but it cannot provide final answers. Only if you are Paul Offitt can epidemiology be the only research one needs to perform.

This is the one question I would like to address to Dr. Offit. Why is it that vaccine manufacturers (and I hope we can all agree that Dr. Offit is an industry insider) have not conducted any clinical or biological research into the possible link between thimerosal-containing or live-virus vaccines and the onset of autism? There seems to be huge fear of legal liability. As an attorney who spends nearly all of his professional time defending corporations and insurance companies, including a lot of products-liability suits, I can tell you that a good scientific defense can save both indemnity and defense costs. It seems to me that the manufacturers would be eager to definitively refute any connection, using the same types of science relied on by those of us who believe in a connection. That would give them the best evidence of all. Their failure to fund that research speaks volumes.

Those studies will not be performed (or if they have already been quietly done, we will not hear of them) because the hypothesis of a connection is simply too plausible. So industry spokesmen like Dr. Offit will continue to talk down to us as if we don’t understand science. And that’s why I find Paul Offit so offensive. He assumes we’re stupid.

6 Comments:

Just FYI Wade: when someone reads a blog via RSS all versions of each post are published, so when (for example) a couple of names are mentioned then published and then you amend the post and publish again then both versions are readable ;o)

Sometimes we write things and regret them after sleeping on it. I realize that good judgment should be exercised before the original post, but the next best thing is to edit out one's indiscretion. My apologies to ... well, you know.

As I've stated numerous times on my blog - if you're trying to ask the question of whether vaccines (or mercury in vaccines) played a role in moving the needle towards the 1 in 166 number we see today, epidemiology is the ONLY way to answer that question. So I think Offit's right in that regard.

I haven't heard Offit's interview, but I don't think that's necessarily inconsistent with saying that autism might have an environmental component, but that component isn't necessarily vaccination. I personally think that's a real possibility - there are MANY factors at work with the increase in autism throughout the years. Some of them are expansion of the ASD criteria and availability of services. Some of them may be external.

I disagree with your assessment of the Burbacher study. The Burbacher study illustrated that ethylmercury clears the body faster than methylmercury, but leaves more inorganic mercury behind. In the study itself, Burbacher doesn't necessarily say that the inorganic mercury left behind is dangerous or even meaningful, because nobody knows if it is or not. (other than one study that postulates that fact) So Offit's again, right on that point.

As to whether methylmercury exposure is more dangerous than ethylmercury exposure, well, there is the pesky fact that methylmercury is everywhere. We can't get away from it. It's in the food we eat, the water we drink and the air we breathe. If mercury is a cause of autism, it would be logical to assume that methylmercury is the prime culprit. You are correct in saying we have no studies to know that for sure, but it's a reasonable hypothesis.

And as I said above, Offit giving more weight to epidemiology IS appropriate. It's how you're going to make decisions about population-based issues. Reductionist studies aren't going to help shape public health policy. They can't, they're not powerful enough, they're not right often enough.

As to the Verstraeten study - while Verstraeten did classify the study as "neutral", I've now talked to three different folks involved with the study who disagree with that assessment. They all agree, however, that a more probative study (and there's one being conducted based on a similar Faroe Islands study several years ago) is necessary.

And as I said on my blog (and confirmed by two different individuals involved with the CDC) the data used in the Verstraeten study IS available for anyone who wants to use it. I've heard that fallacy of the "data is missing" so long now that it's become almost a given, which is a shame.

And as to your claim in a previous comment that Offit has deeply entrenched "vaccine industry ties" - I guess I'd like to see some actual proof of that. Offit himself has said, on numerous occassions, that he does NOT take money from drug companies. I've yet to see someone counter with hard evidence that he does, other than the claims of Merck hush money or misuse of "unrestricted educational grants" that is to date unfounded.

Wade, all in all, I think that Offit's position - while anathema to you - has a fair amount of validity. And as I told Ginger Taylor a while back - you have every ability in the world to prove me wrong. Epidemiological studies. Clinical trials of chelation therapy. Rather than rush headlong into curing kids with treatments that are of questionable validity and effiacy, why not do the due dilligence to know you're right first?

Regarding JP's statement that he'd like to see proof of Dr. Offitt's vaccine company ties, that's easy to do. First, make note of the fact that he holds a patent on RotaTeq, which is a vaccine against rotavirus gastroenteritis, a disease that is almost unknown in the US and causes fairly mild symptoms. It is dangerous only in children who are already weakened by disease or lack of clean water or adequate food.

Further, he is on the scientific advisory board of Merck, which produces RotaTeq.

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